MEDICARE: JUSTIN M BURTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	804823614	TX

General Provider Information

NPI Number	:	1932896925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN M BURTON

Provider Business Mailing Address
First Line	:	12951 HUEBNER RD # 782491
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1547
Country	:	US
Telephone Number	:	210-837-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	12951 HUEBNER RD # 782491
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1547
Country	:	US
Telephone Number	:	210-837-7233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	05/15/2023

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